The purpose of this K08 Mentored Clinical Scientist Award is to prepare Dr. Ann Kutney Lee for an independent health services research career, with a special focus on nursing outcomes research. The career development plan entails three approaches to achieve the immediate and long-term career goals of the candidate, including: 1) the completion of training dedicated to acquiring skills in advanced health services research methods and statistics, and gaining additional content knowledge in the area of chronic illness, 2) the enlistment of an expert mentorship team including Drs. Linda Aiken, PhD, FAAN, RN, Mary Naylor, PhD, FAAN, RN, and Jeffrey Silber, MD PhD, and 3) the conduct of a study to evaluate the longitudinal effects of changes in hospital care organization and patient characteristics (specifically chronic conditions), on patient and nurse outcomes, that will lead to future R-series grant applications. The research project will seek to understand how patient and nurse outcomes over time may be a function of both changes in hospital care organization, including nurse staffing and practice environments, and changes in the complexity of hospital patient populations. This study will employ a retrospective, observational, two-stage panel design to assess longitudinal effects of changes in nurse staffing, practice environments, and patient characteristics on patient and nurse outcomes using secondary data sources. Hospital- and patient-level analyses will be employed to assess the effect of changes in hospital care organization and patient characteristics on the selected patient and nurse outcomes. The specific aims of the research project are: 1) to examine the effect of changes over time in nurse staffing, nurse practice environments and patient characteristics within hospitals on medical-surgical patient outcomes, and 2) to examine the effect of changes over time in nurse staffing, nurse practice environments, and patient characteristics within hospitals on nurse outcomes related to nurse retention. A variety of patient outcomes will be explored, including AHRQ's Patient Safety Indicators and a novel outcome measure called prolonged length of stay. Nurse outcomes will include job satisfaction, burnout and intentions to leave. This proposal will assist policymakers and administrators in the assessment of the impact of changing population health, including the increased prevalence of chronic health conditions, as well as system changes on patient outcomes and hospital quality of care. This study also will provide a preliminary understanding of what investments in nursing are most beneficial to outcomes.